More on raising the Medicare age

WSJ has a debate on raising the Medicare age featuring Maya MacGuineas (yes) and Aaron Carroll (no).

I think Aaron is correct that it is a bad idea in policy terms (and truly dreadful if the ACA is repealed), but I also believe it is virtually inevitable that we will raise the Medicare age as part of any ‘grand bargain’ that moves ahead with the ACA and related changes. As I write in Chapter 7 of my book p. 74-5:

I do not suggest raising the Medicare age as a policy option, because it mostly shifts, and doesnâ€™t reduce costs. Removing the youngest and therefore healthiest sliver of the Medicare program will not revolutionize the cost of the program, but would shift some costs from the federal budget onto beneficiaries or to another aspect of the federal government (income based premium support, for example). In fact, recent analysis suggests that doing this will increase overall health care spending, because all such a policy does is to move persons out of the largest risk pool (Medicare) into a smaller one.

As a stand-alone policy, there is no doubt that raising the Medicare eligibility age this is a bad one. And doing so assumes the implementation of exchanges under the ACA. However, I am open to raising the Medicare age in a manner that equalizes it with the Social Security retirement age as part of a broader political deal that either brings about federally-guaranteed universal catastrophic coverage or an agreement to move ahead with implementation of the ACA that makes reform the responsibility of both parties. For many Conservatives, a move such as this one is a strong signal of seriousness in addressing long range health care cost problems. As I say, I donâ€™t think they are correct, but there is a policy logic of increasing the age along with Social Security increases given that they have been linked for so long. In the end, I would potentially agree to this, so long as what is gained in return is consequential enough.